High-frequency ultrasound features of basal cell carcinoma and its association with histological recurrence risk

Abstract

Background:Due to advances in high-frequency ultrasound technology, it is easier to detect fine structures of skin lesions. The aim of this study was to examine the ultrasonographic features and use recurrence risk stratification to assess the diagnostic performance of pre-operative ultrasound examination of basal cell carcinoma (BCC).Methods:This was a retrospective study. Forty-six BCC lesions underwent pre-operative ultrasound examination using 50- and 20-MHz probes. Ultrasonographic shape, margin, internal echoes, hyper-echoic spots, posterior echoes, and depth of the lesion were evaluated and correlated with the risk of recurrence based on histological features.Results:Forty-two patients had 46 skin lesions in total. The high-risk (n = 6) and low-risk (n = 40) groups exhibited considerable overlap in the ultrasonographic manifestations and no significant difference in margin (χ2 = 3.231, P = 0.072), internal echo (χ2 = 1.592, P = 0.207), or posterior echo (P = 0.169). However, high-risk BCCs tended to be irregular in shape than low-risk lesions (χ2 = 4.313, P = 0.038). Both types presented hyper-echoic spots (χ2 = 1.850, P = 0.174). Additionally, 78% of low-risk lesions were confined to the dermis (31/40), and 100% of high-risk lesions infiltrated into the sub-cutaneous tissue, resulting in a significant difference between the two groups (χ2 = 10.951, P = 0.001). Ultrasound detected sub-clinical lesions in five patients.Conclusions:High-frequency ultrasound can provide important information for pre-operative evaluation of risk in BCC foci and reveal hidden lesions. The technique may play a crucial role in guiding therapeutic options for BCC.

Value of High‐Frequency Ultrasound in Accurate Staging of Mycosis Fungoides/Sézary Syndrome

“…Previous research found that HF‐US can show the depth of invasion of basal cell carcinoma, melanoma, and other cancers and the size of the lesion, providing important information for surgical resection. In addition, it can also stratify the basal cell carcinoma risk, which is helpful to guide clinical treatment, reduce recurrence, and improve the prognosis . In our study, HF‐US could show the infiltration depth and morphologic features of MF lesions, which provide important information for accurate staging of the lesions and is helpful for the choice of treatment.…”

“…Based on previous reports, the following US features were adopted to evaluate MF: epidermal morphologic features (even or uneven), the infiltration depth (the deepest layer of the skin that the lesion infiltrated), the clarity of deep‐border boundaries (clearly or unclearly identified from the underlying skin structures), the homogeneity of internal echoes (homogeneous or inhomogeneous), posterior echoes (presence or absence of hypoechoic regions linearly distributed and perpendicular to the skin surface) and echogenic foci (presence or absence of pointlike hyperechoic structures <5 mm in diameter). To ensure that the lesion image was clear and completely displayed, we used 50‐MHz images whenever possible, especially when the lesions were in the early‐stage group, whereas 20‐MHz images were accepted when the lesions infiltrated into the deep dermis or subcutaneous tissue.…”

Ultrasound Imaging of Nevus Sebaceous of Jadassohn

“…In addition to sharing similar ultrasound characteristics with the rest of the included cases at 18 MHz, the BCC associated with this NSJ was eccentrically located and presented mixed anechoic‐hypoechoic echogenicity with some anechoic oval cystic areas and multiple hyperechoic spots. The histologic result was compatible with an adenoid‐cystic subtype of BCC 14–16 …”

Seborrheic keratosis mimicking basal cell carcinoma under dermoscopy: a case report

“…Due to the wide variation in its clinical features, however, and particularly when both its manifestations and dermoscopic findings of its lesion are atypical, it may be challenging to differentiate SK lesions from other benign or malignant skin tumors. [ 1 , 2 ] We here report a case of SK of an adenoid type that initially imitated pigmented basal cell carcinoma (BCC) upon dermoscopy.…”